What the panel ordered
Petition for Reconsideration denied; authorization of left shoulder surgery upheld based on February 2, 2022 utilization review certification.
Defendant filed a Petition for Reconsideration of the June 20, 2022 Findings and Order that ordered authorization of left shoulder surgery based on a utilization review certification dated February 2, 2022.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The February 2, 2022 utilization review certification was valid because it was based on a documented change in material facts, including additional imaging studies, which justified resubmission and certification despite a prior non-certification on January 11, 2022. The WCJ and WCAB found no error in authorizing the surgery based on the February 2, 2022 certification, and further utilization review was statutorily impermissible after certification.
From the decision · page 4A utilization review decision to modify or deny a treatment recommendation shall remain effective for 12 months from the date of the decision without further action by the employer with regard to a further recommendation by the same physician, or another physician within the requesting physician's practice group, for the same treatment unless the further recommendation is supported by a documented change in the facts material to the basis of the utilization review decision.